Mun-Keat Looi

Europe is facing a staggering shortage of doctors and other healthcare workers. Mun-Keat Looi looks at the extent of the problem and what is being done to tackle it“There is no health without a health workforce,” says Hans Kluge, regional director for Europe for the World Health Organization. But this is exactly what the European Union is facing. In 2022, a WHO report drawing on data from over 50 countries showed the overwhelming extent of the health workforce shortage in the region.1“We could face a crippling shortage of nearly 1.8 million healthcare workers, and the numbers are climbing,” Kluge told the European Health Forum Gastein in September 2023. “In some countries there are just 2.4 doctors for every 1000 people. That’s not a gap. It’s a gulf.”“A shortage of specialist medical practitioners has been identified in 16 out of the 31 countries we are investigating,” says Irene Mandl, head of information and the EURES European employment service unit at the European Labour Authority, referring to her unit’s research.2 “In 15 countries we have shortages of nursing professionals, healthcare assistants, and general medical practitioners. In 11 countries there are shortages of home based care workers. And in about half of the countries we researched the shortages are identified as severe.”Sandra Galliana, director general for health and food safety at the European Commission, says that shortages are not a new problem. “There are long term problems with staff retention, money, motivation, upskilling, and with medical deserts appearing,” she says. “And there is a big hoovering up of staff by the private sector from the public sector.” There are strikes in many countries, she adds, but the problem is “the long term vision—where do we get the staff and how do we cope with staff shortages? In …

BMJ doi: https://doi.org/10.1136/bmj.q54 (Published 16 February 2024) Cite this as: BMJ 2024;384:q54 Mun-Keat Looi

Nancy Olivieri chose to safeguard patients rather than protect her career when she blew the whistle on a drug trial she was leading. She tells The BMJ of her near 30 year fight for transparency and safety and why it will probably never be over### BiographyNancy Olivieri, an internist and haematologist, graduated from McMaster University Medical School in Ontario and holds a masters degree in medical ethics and law from King’s College London and a masters of fine art in creative non-fiction from the University of King’s College, Halifax, Canada. She is a senior scientist at Toronto General Hospital and professor of paediatrics, medicine, and public health sciences at the University of Toronto.In 1982, while still a research fellow at Toronto’s Hospital for Sick Children, Nancy Olivieri began working with children with the common inherited blood disorder thalassaemia major, who are at risk of toxic iron overload as a result of monthly transfusions. In 1988 and 1992 Olivieri launched two clinical trials supported by the Medical Research Council of Canada to evaluate the effectiveness of a new drug, deferiprone, in removing body iron. Early results were promising,1 but during extended exposure to the drug concerns arose of ineffectiveness and toxicity.Raising her concerns with her funders, Olivieri wanted to help protect the patients by informing them of the findings. But she was threatened with legal action by Barry Sherman, then chief executive of the Canadian drug company Apotex, which makes deferiprone and which had recently begun to provide partial funding for her second trial. Both trials were also abruptly terminated, after invocation of a “confidentiality clause” in the trial contract that had been approved by the hospital’s research institute.2 Olivieri published her findings in the New England Journal of Medicine .3Thus began a near 30 …